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Answer Key for Scenario Set Timed quiz


You have scored 64.5 of 108 points

Clinical Simulation 1

Scenario Set 1
Opening Scene
Allison is an active 74-year-old woman who resides with her husband in a single-story home which they have shared for the past 50-years. Allison has previously been diagnosed with hypertension, osteoporosis and age-related macular degeneration (AMD) for which she takes chronic medication. Recently, however, her husband has noticed that Allison is becoming forgetful, and he is becoming concerned about her safety as she has left the stove on, on a few occasions after cooking a meal, and she is not taking her chronic medication consistently (as directed). To seek help, Allison’s husband consulted with their family doctor, who then referred Allison to OT for an evaluation and intervention.

Scenario item 1 of 4

The OTR® meets with Allison and her husband at their home and after interviewing them, proceeds with screening Allison's abilities and identifying her current needs. Which tools should the OTR® select to evaluate Allison?


Your Response
Yes    No
Answer Key Action
Yes 1.
No 2.
No 3.
Yes 4.
No 5.
Yes 6.

Rationale

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Scenario Set 1
Opening Scene
Allison is an active 74-year-old woman who resides with her husband in a single-story home which they have shared for the past 50-years. Allison has previously been diagnosed with hypertension, osteoporosis and age-related macular degeneration (AMD) for which she takes chronic medication. Recently, however, her husband has noticed that Allison is becoming forgetful, and he is becoming concerned about her safety as she has left the stove on, on a few occasions after cooking a meal, and she is not taking her chronic medication consistently (as directed). To seek help, Allison’s husband consulted with their family doctor, who then referred Allison to OT for an evaluation and intervention.

Scenario item 2 of 4

Evaluation results indicate that Allison is currently functioning at an ACL of 4.4. Allison and her husband have stated that they would prefer to age in place, and her husband is prepared to act as her caregiver. As Allison’s safety within the home has been identified as being the main concern at this stage, the OTR® completes a home evaluation. Which modifications is the OTR® MOST likely going to recommend at this stage?


Your Response
Yes    No
Answer Key Action
No 1.
Yes 2.
No 3.
Yes 4.
No 5.
Yes 6.

Rationale

To ensure Allison's safety, both her AMD and declining cognitive level need to be considered.

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Scenario Set 1
Opening Scene
Allison is an active 74-year-old woman who resides with her husband in a single-story home which they have shared for the past 50-years. Allison has previously been diagnosed with hypertension, osteoporosis and age-related macular degeneration (AMD) for which she takes chronic medication. Recently, however, her husband has noticed that Allison is becoming forgetful, and he is becoming concerned about her safety as she has left the stove on, on a few occasions after cooking a meal, and she is not taking her chronic medication consistently (as directed). To seek help, Allison’s husband consulted with their family doctor, who then referred Allison to OT for an evaluation and intervention.

Scenario item 3 of 4

As the evaluation results indicate that Allison has a cognitive impairment, her husband wants to know how he can help Allison keep her mind active. What recommendations should the OTR® provide?


Your Response
Yes    No
Answer Key Action
Yes 1.
Yes 2.
No 3.
No 4.
No 5.
Yes 6.

Rationale

ACL 4 (Goal Directed Actions)- Global cognition is moderately impaired.

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Scenario Set 1
Opening Scene
Allison is an active 74-year-old woman who resides with her husband in a single-story home which they have shared for the past 50-years. Allison has previously been diagnosed with hypertension, osteoporosis and age-related macular degeneration (AMD) for which she takes chronic medication. Recently, however, her husband has noticed that Allison is becoming forgetful, and he is becoming concerned about her safety as she has left the stove on, on a few occasions after cooking a meal, and she is not taking her chronic medication consistently (as directed). To seek help, Allison’s husband consulted with their family doctor, who then referred Allison to OT for an evaluation and intervention.

Scenario item 4 of 4

Allison and her husband ask the OTR® what they can do about Allison’s visual difficulties. They have been told by their doctor that her vision will not improve and may actually deteriorate overtime. What can the OTR® suggest to help Allison compensate for her visual difficulties?


Your Response
Yes    No
Answer Key Action
Yes 1.
Yes 2.
No 3.
No 4.
No 5.
Yes 6.

Rationale

Macular degeneration: Loss of central vision. Other symptoms include sensitivity to glare and difficulty with light changes. Some peripheral vision may remain intact. 2 Types: I. Dry AMD – blurred vision, need for increased light, difficulty recognizing faces. – not treatable, but progression can be slowed through a healthy lifestyle and antioxidant vitamins. II. Wet AMD – straight lines appear wavy. – can be stopped or slowed with injections of anti-angiogenic agents into the eye. Laser surgery to cauterize leaking blood vessels is also an option. Treatment must be provided quickly to minimize vision loss, which can be rapid.

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Scenario Set 2
Opening Scene

An OTR® working in an acute care hospital receives an order to evaluate and treat Cathy, a 76-year-old female who recently suffered a right CVA. A brief chart review completed prior to the evaluation reveals that Cathy has a history of Type II diabetes and hypertension which are controlled with diet and medication. Cathy is married and lives with her husband in a ground floor apartment. When the OTR® enters Cathy’s hospital room, she makes eye contact and greets the OTR® by saying “hello”. She attempts to sit up in bed but requires maximum assistance to transition from supine to sitting due to left-sided deficits secondary to her CVA.

Scenario item 1 of 4

Based on the information in this scenario, how should the OTR® proceed with the evaluation?


Your Response
Yes    No
Answer Key Action
No 1.
Yes 2.
Yes 3.
Yes 4.
No 5.
No 6.

Rationale

As the patient is a new admission, she is in the early stage of recovery and the limitations caused by her CVA and her current functional abilities are not yet clear. From her movement in bed, it can be observed that the patient has no/very limited function in her left upper and lower extremities.

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Scenario Set 2
Opening Scene

An OTR® working in an acute care hospital receives an order to evaluate and treat Cathy, a 76-year-old female who recently suffered a right CVA. A brief chart review completed prior to the evaluation reveals that Cathy has a history of Type II diabetes and hypertension which are controlled with diet and medication. Cathy is married and lives with her husband in a ground floor apartment. When the OTR® enters Cathy’s hospital room, she makes eye contact and greets the OTR® by saying “hello”. She attempts to sit up in bed but requires maximum assistance to transition from supine to sitting due to left-sided deficits secondary to her CVA.

Scenario item 2 of 4

Later on, while observing Cathy eating a meal, the OTR® notices certain behaviors that suggest Cathy is having difficulty attending to all the stimuli within her visual field and the OTR® suspects that Cathy may have a unilateral neglect. What observations would lead the OTRⓇ to this conclusion?


Your Response
Yes    No
Answer Key Action
No 1.
No 2.
Yes 3.
Yes 4.
No 5.
Yes 6.

Rationale

Unilateral neglect is an attention disorder that arises as a result of injury to the cerebral cortex . It is also commonly known as contralateral neglect, hemispatial neglect, visuospatial neglect, spatial neglect, or hemineglect. Unilateral spatial neglect (USN) is commonly defined as the failure to attend or respond to stimuli presented on the side opposite to that of a brain lesion, which cannot be attributed to either sensory or motor defects

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Scenario Set 2
Opening Scene

An OTR® working in an acute care hospital receives an order to evaluate and treat Cathy, a 76-year-old female who recently suffered a right CVA. A brief chart review completed prior to the evaluation reveals that Cathy has a history of Type II diabetes and hypertension which are controlled with diet and medication. Cathy is married and lives with her husband in a ground floor apartment. When the OTR® enters Cathy’s hospital room, she makes eye contact and greets the OTR® by saying “hello”. She attempts to sit up in bed but requires maximum assistance to transition from supine to sitting due to left-sided deficits secondary to her CVA.

Scenario item 3 of 4

To normalize the tone of Cathy’s flaccid left upper extremity, the OTR® decides to base their treatment on the Rood approach. Which techniques should the OTR® incorporate into Cathy's intervention plan to achieve this goal?


Your Response
Yes    No
Answer Key Action
No 1.
Yes 2.
No 3.
Yes 4.
No 5.
Yes 6.

Rationale

The Rood approach uses the assumption that sensory stimulation has the potential to have either an inhibitory or a facilitatory effect on muscle tone. Using appropriate sensory stimuli for evocating the desired muscular response is the basic principle of Rood approach. Rood’s approach has two techniques which have an impact on muscle tone: Facilitatory techniques to improve tone of flaccid muscles and Inhibitory techniques to reduce tone of spastic muscles.

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Scenario Set 2
Opening Scene

An OTR® working in an acute care hospital receives an order to evaluate and treat Cathy, a 76-year-old female who recently suffered a right CVA. A brief chart review completed prior to the evaluation reveals that Cathy has a history of Type II diabetes and hypertension which are controlled with diet and medication. Cathy is married and lives with her husband in a ground floor apartment. When the OTR® enters Cathy’s hospital room, she makes eye contact and greets the OTR® by saying “hello”. She attempts to sit up in bed but requires maximum assistance to transition from supine to sitting due to left-sided deficits secondary to her CVA.

Scenario item 4 of 4

After 3-months of receiving outpatient rehabilitation, Cathy has made limited progress in her recovery and continues to present with a flaccid left upper limb and unilateral neglect. Which goals would be the MOST important to focus on at this stage of Cathy's recovery?


Your Response
Yes    No
Answer Key Action
No 1.
Yes 2.
Yes 3.
No 4.
Yes 5.
No 6.

Rationale

Recovery time after a stroke is different for everyone, it can take weeks, months, or even years. Some people recover fully, but others have long-term or lifelong disabilities. The most rapid recovery usually occurs during the first three to four months after a stroke, but some survivors continue to recover well into the first and second year after their stroke.

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Scenario Set 3
Opening Scene
An OTR® working in a community mental health setting receives an order to evaluate and treat a 44-year-old woman named Cassandra. During the chart review, the OTR® learns that Cassandra has been diagnosed with schizoaffective disorder, depressive type. Background information reveals that she is a single mother, living in a rented home with her 4 daughters who range in age from 10 to 17 years old. The focus of the evaluation is therefore, on assessing independent living skills especially home management and childcare.

Scenario item 1 of 4

Through a screening interview with Cassandra, the OTR® determines that she appears to have occupational performance deficits in her IADLs including meal planning and preparation, money management, and child rearing. Based on these deficits, what additional tests should the OTR® administer?


Your Response
Yes    No
Answer Key Action
No 1.
Yes 2.
No 3.
No 4.
Yes 5.
Yes 6.

Rationale

Individuals with Schizoaffective disorder experience psychotic symptoms, such as hallucinations or delusions, as well as symptoms of a mood disorder- either bipolar type (episodes of mania and sometimes depression) or depressive type (episodes of depression).

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Scenario Set 3
Opening Scene
An OTR® working in a community mental health setting receives an order to evaluate and treat a 44-year-old woman named Cassandra. During the chart review, the OTR® learns that Cassandra has been diagnosed with schizoaffective disorder, depressive type. Background information reveals that she is a single mother, living in a rented home with her 4 daughters who range in age from 10 to 17 years old. The focus of the evaluation is therefore, on assessing independent living skills especially home management and childcare.

Scenario item 2 of 4

Results of the evaluation indicate that Cassandra needs assistance to live independently in the community. Cassandra reports that she has no additional support system to help her at home besides her children. What should the OTR® do to support Cassandra's role as a mother and to ensure both her and her family's safety in the home?


Your Response
Yes    No
Answer Key Action
Yes 1.
Yes 2.
No 3.
No 4.
No 5.
Yes 6.

Rationale

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Scenario Set 3
Opening Scene
An OTR® working in a community mental health setting receives an order to evaluate and treat a 44-year-old woman named Cassandra. During the chart review, the OTR® learns that Cassandra has been diagnosed with schizoaffective disorder, depressive type. Background information reveals that she is a single mother, living in a rented home with her 4 daughters who range in age from 10 to 17 years old. The focus of the evaluation is therefore, on assessing independent living skills especially home management and childcare.

Scenario item 3 of 4

During a session focused on meal preparation, Cassandra demonstrates difficulty focussing her attention and her planning skills are poor which affects her ability to select and prepare appropriate food for family meals. What should the OTR® do to facilitate Cassandra's ability to complete meal preparation tasks?


Your Response
Yes    No
Answer Key Action
No 1.
Yes 2.
No 3.
Yes 4.
Yes 5.
No 6.

Rationale

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Scenario Set 3
Opening Scene
An OTR® working in a community mental health setting receives an order to evaluate and treat a 44-year-old woman named Cassandra. During the chart review, the OTR® learns that Cassandra has been diagnosed with schizoaffective disorder, depressive type. Background information reveals that she is a single mother, living in a rented home with her 4 daughters who range in age from 10 to 17 years old. The focus of the evaluation is therefore, on assessing independent living skills especially home management and childcare.

Scenario item 4 of 4

A few weeks later, when the OTR® arrives at Cassandra's house for a home visit, the therapist finds her crying. Cassandra states she cannot participate in the session because she heard on the radio that the world is going to end. How should the OTR® respond to this situation?


Your Response
Yes    No
Answer Key Action
No 1.
Yes 2.
No 3.
No 4.
Yes 5.
Yes 6.

Rationale

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